title: The clinical assessment of ischaemia modified albumin and troponin I in the early diagnosis of the acute coronary syndrome.
abstract: BACKGROUND
  An early identification of the patients with the Acute Coronary Syndrome (ACS) is of prime importance, due to the associated very high mortality. Only about 22% of the patients who present at the emergency cardiology care centres with chest pain, have coronary disease. Ischaemia modified albumin has already been licensed by the US Food and Drug Administration for the diagnosis of suspected myocardial ischaemia.
  
  
  OBJECTIVE
  The goal of the present study was to assess the diagnostic value of serum ischaemia modified albumin and to compare it with sensitive cardiac troponin I in patients with the acute coronary syndromes like unstable angina and acute myocardial infarction.
  
  
  METHODS
  A diagnostic case control study was conducted on 102 patients who presented to the Emergency Department within 6 hrs of having acute chest pain and on 110 healthy age and sex matched volunteers who formed the control group. The serum Ischaemia Modified Albumin level was estimated by the albumin cobalt binding test by using a digital spectrophotometer, while Troponin I was measured by doing an immunofluroscence assay. A receiver operating characteristic curve was established for ischaemia modified albumin, to determine the cut-off point. The sensitivity and the specificity of ischaemia modified albumin and troponin I for the detection of acute coronary syndromes, were analyzed. The results of ischaemia modified albumin and troponin I alone and in combination, were correlated.
  
  
  RESULTS
  The ischaemia modified albumin (p<0.05) and the troponin I (p<0.001) concentrations were significantly higher in acute myocardial infarction and in unstable angina than in the healthy controls. The sensitivity and the specificity of ischaemia modified albumin for the detection of acute coronary syndromes was 88% and 93% as compared to 87% and 75% respectively for troponin I. The combined use of ischaemia modified albumin and troponin I significantly enhanced the sensitivity to 96%. The area which was under the Receiver Operating Characteristic (ROC) curve of ischaemia modified albumin in acute coronary syndromes was 0.90.
  
  
  CONCLUSIONS
  Ischaemia modified albumin is a useful biochemical marker for the early diagnosis of acute coronary syndrome. The combined use of ischaemia modified albumin and cardiac troponin I enhances the sensitivity and specificity. Hence, a combination of ischaemia modified albumin and cardiac troponin I can be used as a more precise diagnostic marker for Acute Coronary Syndrome.
authors.affiliation: Assistant Professor, Department of Biochemistry, PDVVPF's Medical College , Ahmednagar, (M.S.), India .
authors.forename: Sangita M
authors.initials: SM
authors.lastname: Patil
authors.forename: M P
authors.initials: MP
authors.lastname: Banker
authors.forename: Ramchandra K
authors.initials: RK
authors.lastname: Padalkar
authors.forename: Abhijit P
authors.initials: AP
authors.lastname: Pathak
authors.forename: Sonali S
authors.initials: SS
authors.lastname: Bhagat
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Ghone
authors.forename: Anjali S
authors.initials: AS
authors.lastname: Phatake
keywords: Acute Coronary Syndrome; Ischaemia modified albumin; Myocardial Ischaemia; Troponin I